Статья
Эндоваскулярные методы лечения ишемического инсульта
Основные положения. Механическая тромбэкстракция – «золотой стандарт» лечения пациентов с окклюзией крупных церебральных артерий. Значительный вклад в развитие и внедрение в клиническую практику механической тромбэкстракции внесли пять рандомизированных исследований, проведенных в 2015 г. Исследования DAWN и DEFUSE 3 открыли новое понимание патофизиологии ишемического инсульта и расширения терапевтического окна.Резюме. Инсульт – одна из главных причин смертности и инвалидизации населения во всем мире. Общая стратегия терапевтических мер при ишемическом инсульте направлена на восстановление кровотока в ишемизированные отделы головного мозга. С 1996 г. внутривенная тромболитическая терапия была первой линией лечения больных ишемическим инсультом. Однако с 2015 г. на основании результатов пяти рандомизированных исследований «золотым стандартом» лечения пациентов с окклюзией крупных церебральных артерий стала эндоваскулярная механическая тромбэкстракция. Исследования DAWN и DEFUSE 3 способствовали новому пониманию патофизиологии ишемического инсульта со сменой парадигмы «время – мозг» на «коллатерали – мозг». В данной статье проанализированы этапы развития эндоваскулярных устройств, современные техники механической тромбэкстракции, а также возможные направления дальнейшего исследования эндоваскулярных методов лечения ишемического инсульта.
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